Eating well for new mums including information for breastfeeding mothers

Eating well for new mums including information for breastfeeding mothers

Dr Helen Crawley ISBN 978-1-908924-46-9 (e-book) ISBN 978-1-908924-42-1 (hard copy) Published by First Steps Nutrition Trust. First edition: 2014. Second edition: 2017.

A PDF of this resource is available on the First Steps Nutrition Trust website www.firststepsnutrition.org

The text of this resource, and the photos, can be reproduced in other materials provided that the materials promote public health and make no profit, and an acknowledgement is made to First Steps Nutrition Trust.

This resource is provided for information only and individual advice on diet and health should always be sought from appropriate health professionals.

First Steps Nutrition Trust 112 Queens Road London SW19 8LS E: [email protected] Registered charity number: 1146408

First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age. For more information, see our website www.firststepsnutrition.org

Acknowledgements

First Steps Nutrition Trust would like to thank Jean Crawley for funding the production of this resource.

The original edition was written and this second edition was updated by Dr Helen Crawley. Thanks go to Erica Hocking for help with recipes and food styling. The photos were taken by Helena Little.

First Steps Nutrition Trust would also like to thank all the organisations and individuals who commented on this report, and is very grateful for all the very helpful suggestions and corrections made to the original version. We would particularly like to thank Sarah Weston for original work on this report, as well as Fiona Bayne, Rosemary Brown, Helen Gray, Diana Hawdon, Clare Jones, Beckie Lang, Emma Pickett, Annie Seeley, Sally Tedstone and Diana West.

Edited by Wordworks. Design by Sally Geeve.

Contents

About this guide 4 Eating well for new mums 6 Eating well for everyone 8 Top tips for eating well 14 What does eating well look like for new mums? 16 Ideas for healthy snacks and drinks 18

Breastfeeding and eating well 43 Breastfeeding 44 Eating and drinking well when breastfeeding 45 Special diets 51 Frequently asked questions 52

Additional information 57 Good sources of vitamins and minerals 58 For more information 60 Index 64 4 5 About this guide

ith so much information available advising people what to eat, it can be difficult to work out what eating well really means. Now that you are a Wnew mum, you may have lots of questions about how to make sure that you, and your family, can eat well. All new mums need to eat well for their own health now and in the future, and to make sure they are nutritionally ready for any future pregnancy. The human body is designed to breastfeed babies and you will be able to make milk for your baby without needing a special diet. We want to give all new mums confidence about what a good diet looks like for you, whether or not you breastfeed. This practical guide shows the sorts of foods, and amounts of foods, that will meet your nutritional needs. It also provides lots of examples of easy, nutritious snacks for busy mums, and gives you lots of information on what eating well really means. Why have we produced this Who is this guide for? resource? This guide has been written for new mums, and for anyone who supports them in a The aim of this guide is to illustrate what a professional or voluntary capacity. good diet looks like for new mums. After having a baby, many women find it takes some time We also hope that it will be of interest to policy to adjust to becoming a mother. It is very easy makers, commissioners and managers in health for mothers to overlook their own needs when and well-being boards, GPs, midwives, health their baby needs frequent changing, feeding, visitors, those who support families in children’s settling, bathing and play. Just as a baby needs centres and other early years settings, and all round-the-clock care, a new mum’s body is also those interested in promoting better public working round the clock – to produce breast milk health for all. if you are breastfeeding, to ensure you have the Extra information for breastfeeding mothers energy to cope with busy days and nights, and to can be found on pages 43-55. There are a lot recover from childbirth itself. Young mums may of myths around diet and breastfeeding and still be growing too, and have additional needs we hope that this section will support and to support their own health. Eating a good diet encourage everyone who breastfeeds, and dispel will help all new mums feel good, will help you some of the misinformation about eating and recover, and help you manage the physical and breastfeeding. emotional demands of parenting.

The example menu plans on pages 16-17 show what a good diet might look like for women in their child-bearing years. It is particularly important that mums who plan to have another baby make sure they are nutritionally ready for another pregnancy. For more information on Eating well for everyone, see page 8.

This guide has been written by experts in food and nutrition and uses evidence-based guidelines in the UK for healthy eating. 4 5

The first 1,000 days … The first 1,000 days – that is, the nine months of pregnancy and the first two years of the baby’s life – is a critical window of opportunity to get food and nutrition right so that everyone can reach their full potential. It is never too late to eat better and support your family to eat better, and it is not expensive, or complicated to offer tasty and nutritious food to everyone. For support and advice on how to eat well in pregnancy, see our resources Eating well for a healthy pregnancy: A practical guide, and Eating well in pregnancy: A practical guide to support teenagers. These are available at www.firststepsnutrition.org. For advice on how to ensure children eat well in the first two years of life, see the For more information section on page 60.

Eating well for a healthy pregnancy A practical guide Eating well in pregnancy A practical guide to support teenagers

FIRST STEPS NUTRITION TRUST

First Steps Nutrition Trust is a charity that provides evidence-based practical resources to explain what eating well looks like. We aim to support families from pre-conception to when their children are 5 years of age, and we work within Government public health policy guidelines. We are wholly independent and take no commercial funding, and our work is open access so that anyone can use it to promote good public health, or to help them to eat better themselves. To find out more about the work we do, see www.firststepsnutrition.org 6 7 Eating well for new mums

ongratulations! You have an exciting, tiring and very fulfilling time ahead of you as a new mum, whether this is your first baby or you have already Cexperienced the excitement before. You may feel overwhelmed at all the new experiences coming your way, but you are a fundamentally important person in your new baby’s life and it is really important that you look after yourself, and that includes eating well.

The good news is it is never too late to Want to know start eating better, and eating well is not more about complicated, expensive or dull. This resource breastfeeding? will provide lots of ideas for how to eat well You can find Breastmilk and across the day and where to get lots of good breastfeeding: A simple guide at recipes, and provides photos and recipes for www.firststepsnutrition.org nutritious snacks for mums on the go. For details of other resources about You will also be making decisions about how breastfeeding and organisations that to feed your new baby. We hope you will offer support and advice, have had lots of support and advice from the see page 60. health professionals looking after you in your pregnancy and after the birth. There is also Want to know more lots of support available to you as a new mum about formula feeding? and we give details of national breastfeeding helplines on page 60. Your local midwives, First Steps Nutrition Trust health visitors and children’s centre will be able provides information on formula milks and formula feeding, and you to signpost you to local support in your area. can download Infant milks: A simple If you are breastfeeding your baby, you may guide to infant formula, follow-on have some questions about things you have formula and other infant milks at heard about what (or what not) to eat and you www.firststepsnutrition.org can find answers to lots of frequently asked questions on pages 14 and 52.

Need to talk to someone? Some new mums (and dads) feel overwhelmed or low after the birth of a baby. It is really important to talk to your health visitor, midwife or GP if you or your partner feels like this. It is much more common than you might think and can affect anyone, but you will be listened to and supported. For other organisations that can offer support and help, see page 63. 6 7

Healthy Start Healthy Start is the name for the UK welfare food scheme that aims to improve the health of pregnant women and families on benefits or low incomes and of young mums. All pregnant women and new mothers on the Healthy Start scheme are given free Healthy Start vitamins which contain folic acid and vitamin D to help prevent spina bifida and rickets in babies, and vitamin C for general good health. Women who are supported by the Healthy Start programme are eligible to receive free Healthy Start vitamin tablets during pregnancy and until their child is one year old, and these are designed to be suitable for breastfeeding women. Currently, children aged from 6 months to 4 years in families eligible for Healthy Start can get free vitamin drops. It is now recommended that all breastfed babies have a vitamin D supplement from birth as a precaution, and all formula-fed babies when they have less than 500ml of formula a day. In some areas of the UK all babies are given Healthy Start supplements from birth or 1 month of age free of charge. Healthy Start vitamins will be reformulated and offered to all infants from birth in eligible families from 2018. Making the most ofA Healthypractical guideStart Healthy Start also provides food vouchers which can be used to buy plain milk, and fresh and frozen fruit and vegetables. For a guide on Making the most of Healthy Start, see www.firststepsnutrition.org For more information about Healthy Start, see www.healthystart.nhs.uk Eating well recipe book

Simple, cost-effective ideas 1 for the whole family

Need some simple family recipes? You can find a simple family recipe book on our website at www.firststepsnutrition.org. The Eating well recipe book shows how recipes can be adapted for everyone in the family, and the sort of portion sizes that provide the energy and nutrients needed, for a main meal, by different family members. The recipes are all easy and cost-effective, and require minimal cooking skills and equipment. You can download individual recipes and get tips and ideas on how to use simple ingredients as the basis of family meals. 1 8 9 Eating well for everyone

he information on the next few pages summarises public health advice on what a good diet looks like for adults, and provides some practical tips on Twhat the advice means in practice. Eatwell Guide Check the label on packaged foods Use the Eatwell Guide to help you get a balance of healthier and more sustainable food.

Each serving (150g) contains It shows how much of what you eat overall should come from each food group. 6-8 Energy Fat Saturates Sugars Salt a day 1046kJ 3.0g 1.3g 34g 0.9g Choo 250kcal ay se LOW LOW HIGH MED y d wh ver ole s e gra 13% 4% 7% 38% 15% ble in o eta Pota r h eg toe ig Water, lower fat of an adult’s reference intake v s, b he Typical values (as sold) per 100g: 697kJ/ 167kcal nd re r fi t a ad br milk, sugar-free ui , ri e fr Raisins ce ve drinks including Choose foods lower of s , p rs y le as io tea and coffee in fat, salt and sugars t ab t n rie t a s all count. a ge an w v e Potatoes d it a v o h f d t l Limit fruit juice o n h e a e s and/or smoothies s t r s n i s a o u ta to a total of ti r d r F rc d o h e 150ml a day. p Chopped y d

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n a Le ce Plain Chick min nuts peas Veg Semi Oil skimmed ya Lower fat So spread Plain Crisps milk drink Low fat yoghurt Sauce B ean es Oil & spreads s, ativ Ea puls ern t m es, d alt so o fish, y an and Choose unsaturated oils ur re b eggs, Dair fat re ce ean meat and other proteins wer s and use in small amounts d a d fi s an se lo tion nd sh d pu hoo r op pr per w lses, 2 po bly C uga oce eek, rtions of sustaina wer s ssed one of w s lo Eat less often and meat hich is oily. Eat les in small amounts Per day 2000kcal 2500kcal = ALL FOOD + ALL DRINKS

Source: Public Health England in association with the Welsh Government, Food Standards Scotland and the Food Standards Agency in Northern Ireland © Crown copyright 2016

Meals and snacks should be based around these two It is also important to include foods from these two food groups: food groups: • Potatoes, bread, rice, pasta and other starchy • Dairy and alternatives provide useful nutrients and carbohydrates. These foods should make up over one- should be eaten every day in moderate amounts. third of the food we eat. Choose wholegrain or higher Choose lower-fat and lower sugar options. fibre versions with less added fat, salt and sugar. • Beans, pulses, fish, eggs, meat and other proteins. • Fruit and vegetables. These should make up more than Eat more beans and pulses and two portions of one-third of the food we eat. Eat at least five portions of sustainably sourced fish every week, one of which is oily. a variety of fruits and vegetables every day.

Foods and drinks high in fat and/or sugar should be limited in the diet as eating these foods and drinks means that it may be harder to get in all the nutrients you need without having too much energy (calories). Oils and spreads: Choose oils and fats which are unsaturated, and use in small amounts. Drinks: Have 6-8 drinks a day. Water, lower fat milk, sugar-free drinks including tea and coffee all count. Limit fruit juices and/ or smoothies to 150ml per day as the sugars in these drinks can damage teeth and contribute to overweight. 8 9

Food group: Potatoes, bread, rice, pasta and other starchy carbohydrates ADVICE WHY? WHAT’S INCLUDED

Starchy foods – which include Starchy foods are a good source All varieties of bread including potatoes, bread, rice and pasta of energy and the main source of wholemeal, granary and seeded – should make up a third of the a range of nutrients in the diet. breads, chapattis, bagels, roti, daily diet. As well as starch, these foods tortillas and pitta bread supply fibre, calcium, iron and Eating a variety of breads and B vitamins. Potatoes, yam, cocoyam, other starchy foods such as rice dasheen, breadfruit and cassava and pasta, including those with more wholegrain flour, will add Breakfast cereals additional nutrients and fibre to the diet. Rice, couscous, bulgar wheat, maize (polenta) and cornmeal

Noodles, spaghetti and other pastas

TIPS • Potatoes are a useful starchy food as they are cheap, locally produced, contain a range of useful nutrients and are very versatile. • Have more pasta and rice and use less sauce. Choose tomato-based sauces instead of cheese-based sauces. • When serving rice and pasta, try to use wholemeal, wholegrain, brown or high-fibre versions. • Some breakfast cereals are nutrient-fortified (that is, with added iron, folic acid and other vitamins and minerals), but avoid those that are high in sugar (those with more than 15g of sugar per 100g of cereal). • Eat a variety of breads, such as seeded, wholegrain and granary. Use thicker slices and have low-fat options for fillings. • If you’re making chips or fried potatoes, use large pieces of potato and have thick or straight-cut chips as these absorb less fat. • Baked potatoes do not need to have butter or margarine added when served with moist fillings or sauces. • For people who have allergies to wheat, oats, barley or rye, good alternatives to offer are foods made from maize (such as polenta), rice, rice flour, potatoes, potato flour, buckwheat, sago, tapioca, soya and soya flour. • Cereal foods which are good sources of iron and zinc include fortified cereals, wholegrain cereals, wholemeal bread and flour, couscous and wholemeal pasta. 10 11

Food group: Fruit and vegetables ADVICE WHY? WHAT’S INCLUDED

Fruit and vegetables should make Fruit and vegetables are good All types of fresh, frozen and up about a third of the daily diet. sources of many vitamins and canned vegetables – for example, minerals. broccoli, Brussels sprouts, Try and eat at least 5 portions cabbage, carrots, frozen peas, a day. A portion is about 80g There is evidence that consuming peppers, swede and sweetcorn (a whole fruit, like an apple or 400g or more of fruit and orange, or 2 to 3 tablespoons vegetables a day reduces the risk Beans and pulses, including baked of vegetables, or a small glass of of developing chronic diseases beans, chick peas and kidney fruit juice.) such as coronary heart disease beans and some cancers. A 150ml glass of 100% fruit or All types of salad vegetables, vegetable juice, or 100% fruit Including fruits and vegetables in including lettuce, cucumber, and vegetable based smoothie, the diet will help to increase the tomato, raw carrots, peppers and can count as 1 portion of fruit or intake of fibre. beetroot vegetables each day. All types of fresh fruit – for Dried fruit contains useful example, apples, bananas, kiwi nutrients but if eaten between fruit, oranges, pears, mango and meals can damage teeth. So plums eat dried fruit with meals – for All types of canned fruit in fruit example, with breakfast cereals juice – for example, pineapple, or desserts. peaches and mandarin oranges Aim for 1 or 2 portions of fruit Stewed fruit or vegetables with each meal, and have fruit and vegetables as Dried fruit snacks. Fruit juice (100% juice) or fruit and vegetable only smoothies. Have no more than 150ml of fruit juice and/or smoothies a day.

TIPS • Steaming or cooking vegetables with minimum amounts of water, and serving them as soon as possible, will help retain vitamins. • Use fresh fruit and vegetables as soon as possible, rather than storing them, to avoid vitamin loss. • Incorporate fruit and vegetables in snack options. Many vegetables can be eaten raw. • Add vegetables and pulses to curries, casseroles or stir-fry dishes and have at least two types of vegetables with fish, chicken or meat. • One daily glass (150ml) of 100% fruit or vegetable juice or 100% fruit and vegetable smoothie can help iron absorption, so have with a meal such as breakfast. • Add a handful of dried fruit to cereals, porridge and desserts like rice pudding. • Raw vegetables can increase colour, taste and texture at mealtimes, but if eating vegetables and fruit raw, always wash them before eating. • Add extra vegetables to dishes such as Bolognese sauce, shepherd’s pie, curries, stews and soups. • Fruit and vegetables which are useful sources of iron include spinach, broccoli, spring greens, dried apricots, raisins, baked beans, broad beans and blackcurrants. • Fruit and vegetables which are useful sources of folic acid include spinach, broccoli, peas, oranges, melon, green leafy salads and tomatoes. • Fruit and vegetables which are useful non-dairy sources of calcium include green leafy vegetables, dried fruit and oranges. 10 11

Food group: Dairy and alternatives ADVICE WHY? WHAT’S INCLUDED

Have dairy foods such as milk, Milk and dairy products are good Skimmed, semi-skimmed, 1% fat yoghurt and cheese every day (if sources of calcium, protein and and whole milk you eat these foods). vitamin A. Calcium helps to Dried milk, goats’ and sheep’s contribute to good bone health. milk Have low-fat options such as The fat content of different dairy Cheeses – for example, Cheddar semi-skimmed milk or 1% products varies and much of this cheese, cottage cheese, cheese fat milk, low-fat yoghurt and is saturated fat. spreads, feta, Edam, goats’ reduced-fat cheeses. cheese and Parmesan If you choose milk alternatives, Vegetarians should not rely on make sure they are unsweetened Yoghurt cheese as the main protein item. and fortified with calcium. Fromage frais If you don’t eat dairy foods (for Unsweetened fortified milk example, because you are vegan alternatives made from soya, nuts, or lactose-intolerant), calcium- oats, coconut or hemp, and products fortified unsweetened soya milk such as yoghurt or cheese made or other alternatives can be used from these alternatives. instead of cows’ or other animal milk.

TIPS • Choose reduced-fat hard cheeses, cottage cheese or low-fat soft cheese. • Some dairy products can contain high levels of salt. Look for lower-salt cheeses and use smaller amounts of stronger cheese rather than larger amounts of milder cheese. • Have semi-skimmed, 1% fat or skimmed milk, and low-fat yoghurts and fromage frais. • Use plain yoghurt or fromage frais instead of cream, soured cream or crème fraîche in recipes. • Try frozen yoghurts as an alternative to ice cream. • If you are on a dairy-free diet, have unsweetened calcium-fortified milk alternatives in place of milky drinks. • Avoid sweetened milk drinks, as the sugars in these drinks can damage the teeth. 12 13

Food group: Beans, pulses, fish, eggs, meat and other proteins ADVICE WHY? WHAT’S INCLUDED Everyone is encouraged to eat Beans, pulses, eggs, meat Beans and pulses such as chick more pulses and beans in their alternatives such as tofu, tempeh, peas, lentils, kidney beans, butter diet. Vegetarians and vegans textured vegetable proteins, and beans, textured vegetable protein, should eat a range of meat nuts all provide good sources of nuts, nut butters, seeds, soya alternatives. nutrients. products such as tofu, and Quorn. Everyone is encouraged to eat Choose sustainably sourced fish. Fish includes all fresh and two portions of sustainably Good white fish options include frozen fish (including coley, cod, sourced fish a week, one of which coley, pollack, hake, flounder, dab haddock, mackerel, salmon, is an oil-rich fish such as salmon, and whiting. trout), canned fish (such as trout, mackerel, herring, pilchards sardines, tuna, pilchards) and Oil-rich fish provides a good or sardines. shellfish or crustaceans (such source of omega-3 fats, which as crab, lobster, prawns and Limit the amount of processed may help to protect against heart mussels). Choose sustainably fish and dishes (such as fish cakes, disease. Oil-rich fish are also a sourced fish. Good white fish fish fingers and battered fish source of vitamins A and D. options include coley, pollack, products). Fish products such as fish cakes hake, flounder, dab and whiting. and fish fingers may have a low fish Find out more at www.mcsuk.org content and may be high in fat and salt. Eggs can be eaten at breakfast Eggs are a good source of Boiled, poached or scrambled and as part of main meals. protein, vitamin A, vitamin D, eggs, or omelettes. choline and some minerals. Eat a variety of meat and meat Meat and meat alternatives are a Meat includes all cuts of beef, alternatives at main meals. good source of protein, vitamins pork, lamb, poultry (chicken and and zinc. turkey), game (such as venison or Use lean meat (meat which has rabbit), offal (such as liver, kidney a fat content of about 10%) and Some meat and meat products or heart), and meat products limit the amount of processed can contain a lot of fat, saturated such as bacon, sausages, meat products consumed, such fat and salt, and buying meat beefburgers, pies and cold meats as sausages, burgers, canned diluted with other ingredients is such as ham or salami. meats, pies, pasties and crumbed poor value for money. or battered meat products.

TIPS • Eggs and canned pulses such as chick peas and red kidney beans, or easy-to-use dried pulses such as lentils, are cheap alternatives to meat and fish. • Buy good-quality meat and use smaller amounts. • Use more vegetables, pulses and starchy food to make meals go further, and to add more texture and flavour. This will also mean that less meat is needed, reducing both the fat content and the cost of the meal. • Avoid cheap processed meat products such as sausages, burgers, canned meat products, coated and battered products, pies, pasties and sausage rolls. These often contain small amounts of meat but lots of fat and salt, and are not good nutritional value for money. • Always cook meat dishes thoroughly, particularly if they are bought ready-prepared. Make sure that any leftover meat dishes are stored and reheated safely. • Tinned fish provides useful nutrients and can be a cost-effective ingredient in recipes. • Frozen fish is often cheaper than fresh fish. • Buy fish from sustainable fish stocks. Look for the Marine Stewardship Council logo. • Reduce the amount of processed fish products eaten – particularly those that are fried or coated, such as fish fingers or fish cakes – as these are often poor nutritional value for money. 12 13

Foods and drinks high in fat and/or sugar ADVICE WHY? WHAT’S INCLUDED

Fatty and sugary foods can add Foods that are high in fat and/or Foods containing fat include: palatability to the diet but should sugar often provide a lot of butter, margarine, other be eaten in small amounts each calories and a lower proportion spreading fats and low-fat day. of other nutrients. spreads, cooking oils, oil-based salad dressings, mayonnaise, Reduce the amount of foods Some foods in this group are cream, chocolate, crisps, biscuits, containing fat – for example, fat also high in sodium/salt. pastries, cakes, puddings, ice spreads and butter, cooking oils Foods and drinks containing cream, rich sauces, and gravies. and mayonnaise. sugar often contain few other Foods and drinks containing Other foods containing fat nutrients, and having them sugar include: soft drinks, sweets, and sugar – such as cakes and frequently between meals can chocolate, jams, sugar, cakes, biscuits – should be eaten only contribute to tooth decay. puddings, biscuits, pastries and occasionally. ice cream.

TIPS • Use fat spreads rich in monounsaturated or polyunsaturated fats. • Use cooking oils high in monounsaturates, such as soya, rapeseed or olive oils. • Avoid serving pastry dishes frequently. • Have low-fat yoghurt with puddings or pies, rather than cream. • Base desserts on fresh fruit, canned fruit in juice, and yoghurt or low-fat custard. • Have water, unsweetened fruit juices and chilled milk drinks rather than sugary soft drinks. • Have wholegrain or plain cereals rather than sugar-coated cereals. • If you currently add sugar to hot drinks such as tea and coffee, try cutting back a little bit at a time to get used to a less sweet taste.

SALT Having too much salt in the diet can lead to high blood pressure, which can contribute to stroke and coronary heart disease in later life. Everyone is encouraged to limit their salt intake to no more than 6g a day. Most of the salt we eat is in processed and ready-prepared foods, and cooking for yourself is the best way of cutting down on added salt (and sugar) in meals and snacks. Foods that have a lot of salt • Ready-made soups • Bottled pasta sauces and other cooking sauces • Sauces, spreads, pickles, chutneys and soy sauce • Mayonnaise and salad cream • Savoury ready meals • Savoury snacks such as crisps, salted nuts, papadums and savoury biscuits • Bread, rolls, garlic bread and flavoured breads • Fast food or take-aways such as pizza, burgers, and Chinese and Indian take-away meals • Meat pies and pasties, and canned meat products • Smoked foods and smoked meats such as ham and bacon • Some sweet foods such as buns, pastries and hot chocolate powder 14 15 Top tips for eating well

There are few key things that might help you to eat well now you are a new mum: •If you share where you live with a partner or other family members, try to eat together at meal times and all eat the same healthy food. •Make sure foods that you like and that are good options are easily to hand: chopped up fruit and vegetables, yoghurt, wholegrain bread, and cooled water in the fridge. •If other people are helping you with shopping, be specific about what you want them to buy. •If you find shopping difficult with a new baby in tow, find out about vegetable box and other food box scheme deliveries in your area. This is often good, local and organic food at reasonable prices and you are also supporting your local farmers. •In some areas you can still have a milk delivery to your door, which can be useful in the first few months after a new baby arrives. You may be able to get other foods like bread and juice in the same delivery. •If friends and family come and visit, ask them to bring you fruit baskets rather than cakes and sweets, or even a healthy casserole you can freeze for another day. People usually love to help and being given specific ideas can be helpful for them too.

What can I do to make sure I get back to the weight I was before my pregnancy? Most people will want to get back to their pre-pregnancy weight in the months after they give birth, but women are all different, and however you choose to feed your baby you may find it takes a while to return to your pre-pregnancy weight. Breastfeeding can really help with long-term weight management. It is probably a good idea to wait until the six-week check after giving birth before considering your weight and body shape, so that you have recovered from the birth and, if you are breastfeeding, so that this has become established. Many women find that their body rapidly returns to its pre-pregnancy shape once breastfeeding is well established and they are back to the same active lifestyle they had before becoming pregnant. Evidence suggests that, after three to four months, breastfeeding women are slimmer than formula-feeding women who eat fewer calories. If you are worried about your weight, talk to your midwife, health visitor or GP, as there is specific advice they can offer to women after childbirth. 14 15

How soon after childbirth can I start exercising again, and how much should I do? Most women are able to start doing gentle post-natal exercises very soon after they have given birth to their baby. Finding ways to incorporate activity into the day – by going for a walk or a swim, doing some yoga or pilates or a post-natal exercise class with trained instructors – can all help burn energy, shake off tiredness and lift the spirit. If it proves difficult to fit other exercise into your life, walk for at least half an hour every day with your baby in a sling or buggy. Walking is the best exercise for everyone, and taking your baby out for a walk is a good way of encouraging them to nap as well. •Wait until your baby is at least 6 weeks old before you start more strenuous exercise. •Start your exercise slowly and gradually. If you’re thinking of doing a very strenuous exercise that you have not done for a while, take advice from a health professional first, so that you don’t cause an injury. •Be sure to consume liquids to replace those lost by sweating. •Don’t do too much, too soon. And don’t take on activities that mean you will be away from your baby for long periods. •There is no reason not to breastfeed after exercise. I’m planning to have another baby. Is there anything special I need to do in relation to my diet?

It’s important that you give your body a chance to recover nutritionally before you conceive again, if you can. If you plan to have just a short space between your pregnancies, eating a good diet is particularly important, so following the advice in Eating well in pregnancy this resource will be useful. A practical guide to support teenagers If you take a Healthy Start vitamin for pregnant or breastfeeding mums, carry on taking this, as it will provide the folic acid that is important for women planning a pregnancy. If you just take a vitamin D supplement when breastfeeding, you may want to Eating well for a healthy pregnancy

carry on taking this and add a folic acid supplement from the A practical guide time you start thinking about another pregnancy.

For advice on eating well for pregnant women, see Eating well for a healthy pregnancy, and for young pregnant women (under 19 years of age) see Eating well in pregnancy: A practical guide to support teenagers. 16 17 What does eating well look like for new mums?

ll new mums need to eat well and the example menus below show the sorts of eating patterns that will meet the energy and nutrient needs of most Awomen of child-bearing age. Recipes for all the snacks in these menu plans, and photos of them, are on pages 21-42. The recipes for the main dishes are all in our resource Eating well for a healthy pregnancy. Or you can download any of the recipes at www.firststepsnutrition.org

Breakfast Breakfast Eggy bread with baked beans Weet bisks with milk and raisins Snack Snack Glass of semi-skimmed milk and banana

Carrot cake Lunch Small glass of semi-skimmed milk Lentil and carrot soup and bread Packed lunch Snack Cream cheese bagel with boiled egg, Malt loaf with satsuma cucumber and celery sticks Breakfast Milky coffee Malt loaf and a pear Peanut butter and banana sandwich Snack Apple Evening meal Orange juice Chicken and mushroom pie Baguette with houmous, carrot and cucumber sticks and vegetables Lunch Quick microwave sponge pudding Sweetcorn chowder with Evening meal and custard toasted tortilla Creamy chicken and leek hotpot Fruit scone with jam Greek yoghurt with banana Snack Gingerbread loaf Tea

Evening meal Jacket potato with roasted vegetables and tomato filling Rice pudding with canned mandarin oranges

If you are breastfeeding, you may want to choose decaffeinated tea and coffee. (For more information on caffeine see page 49.) 16 17

Breakfast Breakfast Porridge with jam Muesli with milk Orange juice Orange juice

Lunch Snack Veggie burger and salad Toasted teacake Soya yoghurt with mango Tea Snack Lunch Pitta bread crisps with a chilli dip Vegetable biryani and grapes Fruit fool Milky coffee Snack Evening meal Mixed dried fruit and nuts Shepherdess pie Tea Baked banana

Evening meal Evening snack Jacket potato with tuna, sweetcorn Malted milk drink and soft cheese Poached pear with Greek yoghurt

and honey

Breakfast Granola with apple and milk Milky coffee Breakfast Lunch Scrambled egg and tomato with toast Fish pie with broccoli Orange juice Apple crumble Lunch Snack Mexican bean and cheese wrap with red Dates and sunflower seeds pepper and celery Melon Milky coffee

Evening meal Snack Pitta with houmous and cucumber with Bowl of mixed nuts and almond milk Tea carrot salad Orange Evening meal Vegetable curry with lentil dahl and rice Mango fritters with yoghurt

Evening snack Crumpet, soft cheese and kiwi Yoghurt and fresh fruit smoothie 18 19 Ideas for healthy snacks and drinks

s a new mum you may find you are always on the go, and it is important to make sure that you get all the nutrients you need, even if you end up having Alots of smaller snacks rather than main meals. There are some particularly important nutrients that women need in their child-bearing years, and the snacks and drinks suggested here are designed to provide a wide range of nutrients. To make it easy, we have colour-coded snacks and drinks by their calorie content as shown below. If you avoid dairy products, it is particularly important that you get important nutrients such as calcium, riboflavin and iodine from other food sources. So choose the snacks and drinks that we have highlighted as ‘dairy-free’.

AMBER PINK 50kcal 200kcal Snacks and Snacks drinks BLUE 100kcal Snacks and GREEN drinks 250kcal Snacks

A moderately active woman of child-bearing age If you’re trying to lose weight after the birth of needs about 2,100kcal a day. The main meals your baby, or if you’re very active, make sure we suggest in our menu plans on pages 16-17 you talk to your midwife or health visitor about each provide about 500kcal. So, for example, if this, as they can offer you special advice about you have two main meals each day, you can have how to manage your energy intake safely and about another 1,000kcal a day in snacks and may be able to refer you to a dietitian. For more drinks, and you can fit these in around the other information about managing weight and activity activities you do. after birth, see page 14.

Breastfeeding and feeling hungry? Some breastfeeding mums feel very hungry when they are breastfeeding, and may also be more thirsty. See page 45 for advice about eating well while breastfeeding. 18 19

Snacks Snacks and drinks 50kcal and drinks 100kcal

Small glass of milk Milk Low-fat yoghurt and berries Lassi Milky tea with digestive biscuit Dairy-free options Malted milk drink Apple Milky decaffeinated coffee Canned mandarins Milky decaffeinated tea Carrot and pepper Chocolate milkshake Dried apricots Yoghurt and fresh fruit smoothie Dried figs Soft cheese and banana platter Grapes Mozzarella and pear platter Melon Custard with apricots Pear Frozen yoghurt with grapes Pineapple Plums Dairy-free options Soya yoghurt with mango Soya milkshake Soya milk with apple Carrot sticks and houmous Sunflower seeds Dates 20 21

Snacks Snacks 200kcal 250kcal Mashed avocado on Cheese and tomato melba toast with cherry quesadillas tomatoes and red pepper French toast sticks, with milk Leek and potato soup with a wholemeal roll Popcorn and apple slices, with milk Tuna melt muffin Oatcakes, celery sticks and houmous, with milk Mexican scrambled egg wrap Wholemeal toast with honey and apple slices, Pitta bread pizza with milk Scrambled egg and tomato with toast and a Crumpet, soft cheese and kiwi small glass of orange juice Spicy potato wedges with tomato salsa, with Tortilla crisps with a curry dip and apple milk Apple and cinnamon crumble and custard

Dairy-free options Mango fritters with yoghurt Pitta bread, houmous, pepper and cucumber Porridge with jam and a small glass of orange sticks, and soya milk juice Boiled egg and wholemeal toast Quick microwave sponge pudding and custard Poached egg on toast with tomatoes Rice pudding with canned mandarin oranges Tomato soup and crispbread Weet bisks with milk and raisins

Malt loaf with a satsuma Dairy-free options Pear and almonds Baguette with houmous, and carrot and cucumber sticks Baked beans and French stick Chick pea dahl with chapatti Liver pâté and oatcakes, with celery sticks Mini fish finger sandwich Mixed nuts and almond milk Sardines on toast, with tomatoes Omelette with grilled tomato and toast and a small glass of orange juice Baked banana Pitta bread crisps with a chilli dip and grapes Carrot cake 20 21

Snacks and drinks 50kcal

Small glass of milk Low-fat yoghurt and berries

Semi-skimmed milk 100ml Low-fat plain yoghurt 100g Berries 40g

Apple DAIRY-FREE Canned mandarins DAIRY-FREE

Apple 100g Canned mandarins in juice 150g

Carrot and pepper DAIRY-FREE Dried apricots DAIRY-FREE

Raw carrot 75g Dried apricots 35g Raw pepper 75g 22 23 Snacks and drinks 50kcal

Dried figs DAIRY-FREE Grapes DAIRY-FREE

Dried figs 25g Grapes 90g

Melon DAIRY-FREE Pear DAIRY-FREE

Melon 200g Pear 120g

Pineapple DAIRY-FREE Plums DAIRY-FREE

Pineapple canned in juice 100g Plums 150g 22 23

Snacks and drinks 100kcal

Milk Lassi

Semi-skimmed milk 200ml Lassi 200ml

Lassi This recipe makes 1 portion of about 200ml. 60g plain yoghurt 140ml milk 1/2 teaspoon sugar

1. Mix the ingredients together in a jug or in a large jar and serve at room temperature.

Milky tea with digestive biscuit Malted milk drink

Milky tea 100ml tea, 100ml milk Malted milk drink made with semi-skimmed milk 150ml Digestive biscuit 16g 24 25

Snacks and drinks 100kcal

M i l k y d e c a f f e i n a t e d c o f f e e Milky decaffeinated tea

Decaffeinated coffee made with semi-skimmed milk 200ml Decaffeinated tea made with semi-skimmed milk 200ml

Chocolate milkshake Yoghurt and fresh fruit smoothie

Chocolate milkshake Yoghurt and fresh fruit smoothie 200ml (made with semi-skimmed milk) 150g Yoghurt and fresh fruit smoothie Chocolate milkshake This recipe makes 4 portions of about 200ml. This recipe makes 1 portion of about 150ml. 400g natural yoghurt 3 teaspoons chocolate milkshake mix powder 100ml milk 150ml semi-skimmed milk 320g berries (blueberries, strawberries, blackberries) 1. Mix the milk and chocolate milkshake mix powder and stir Each portion uses 100g yoghurt, 25ml milk and 80g berries. well, or put it in a large jar, screw on the lid and then shake 1. Place all the ingredients into a blender and blend until it up. smooth. Or, place in a jug and blend using a hand-held blender. Serve immediately. 24 25

Snacks and drinks 100kcal

Soft cheese and banana platter Mozzarella and pear platter

Soft cheese 30g Mozzarella cheese 35g Banana 80g Pear 80g

Custard with apricots Frozen yoghurt with grapes

Custard with apricots 110g Frozen yoghurt 60g Grapes 80g Custard with apricots This recipe makes 4 portions of about 110g. Frozen yoghurt This recipe makes 4 portions of about 60g. 280g custard (home-made or ready-prepared) 160g dried apricots, chopped 240g yoghurt

Each portion uses 70g of custard and 40g of chopped dried 1. Put the yoghurt in a freezable tub and place in the freezer. apricots. 2. Mix the yoghurt every hour or so for about 2 to 3 hours to avoid ice crystals forming. 3. Freeze overnight. 26 27

Snacks and drinks 100kcal

Soya yoghurt with mango DAIRY-FREE Soya milkshake DAIRY-FREE

Plain soya yoghurt 100g Soya milkshake 300ml Mango 100g Soya milkshake Soya yoghurt with mango This recipe makes 1 portion of about 300ml. This recipe makes 4 portions of 200g. 200ml soya milk 400g yoghurt 80g drained canned peaches (canned in juice) 1 large mango, peeled and de-stoned (= 2/3 of a small 200g can of peaches) 1. Place all the ingredients in a blender or jug and blend until smooth.

Soya milk with apple DAIRY-FREE Carrot sticks and houmous DAIRY-FREE

Unsweetened calcium-fortified soya milk 200ml Carrot sticks 100g Apple 80g Houmous 30g 26 27

Snacks and drinks 100kcal

Sunflower seeds DAIRY-FREE Dates DAIRY-FREE

Sunflower seeds 20g Dates 40g 28 29

Snacks 200kcal

Mashed avocado on melba toast with cherry Popcorn and apple slices, with milk t o m a t o e s a n d r e d p e p p e r s t i c k s , w i t h m i l k

Mashed avocado 30g Popcorn 15g Melba toast 15g Apple 80g Cherry tomatoes 40g Milk (semi-skimmed) 150ml Red pepper sticks 40g Milk (semi-skimmed) 150ml

Oatcakes, celery sticks and houmous, with milk Oatcakes 30g Celery sticks 40g Houmous 40g Milk (semi-skimmed) 150ml

Houmous This recipe makes 4 portions of about 40g.

Half a 400g can of chickpeas, drained (about 120g drained weight) 1 tablespoon lemon juice 1 tablespoon tahini (sesame seed paste) 1 teaspoon garlic paste 1 tablespoon water

1. Place all the ingredients in a blender and blend until a smooth or chunky paste, depending on your preference. If you don’t have a blender, mash all the ingredients together with a fork. 28 29

Snacks 200kcal

Wholemeal toast with honey and apple Crumpet, soft cheese and kiwi slices, with milk

Wholemeal toast 35g Toasted crumpet 50g Honey 10g Low-fat soft cheese 30g Apple 80g Kiwi 1 kiwi, peeled and sliced Milk (semi-skimmed) 150ml

Spicy potato wedges with tomato salsa, with milk

Spicy potato wedges 70g Tomato salsa 40g Milk (semi-skimmed) 150ml

Spicy potato wedges This recipe makes 4 portions of about 70g.

2 medium potatoes 4 tablespoons vegetable oil 2 teaspoons lemon juice 2 teaspoons mustard powder 2 teaspoons paprika

1. Heat the oven to 200°C / 400°F / Gas 6. 2. Scrub the potatoes and cut each one into 8 wedges. 3. Place the remaining ingredients in a jug and whisk together. 4. Put the wedges in a roasting tin (in a single layer), pour the dressing over and mix well. 5. Cook on the top shelf of the oven for about 30 minutes, turning once after 15 minutes. 30 31

Snacks 200kcal

Pitta bread, houmous, pepper and cucumber sticks, and soya milk DAIRY-FREE Pitta bread 30g Houmous 40g Red pepper sticks 40g Cucumber sticks 40g Soya milk 150ml

Boiled egg and wholemeal toast Poached egg on toast with tomatoes DAIRY-FREE DAIRY-FREE

Egg 60g Egg 60g Wholemeal toast 40g Wholemeal toast 40g Tomatoes 20g Boiled egg and wholemeal toast This recipe makes 4 portions of about 100g. Poached egg on toast with tomatoes This recipe makes 4 portions of about 100g. 4 eggs 4 slices wholemeal bread 4 slices wholemeal bread 4 eggs 1. Place the eggs in a pan of cold water and bring to the 8 small tomatoes, cut in half boil. 2. Boil the eggs for about 4 to 5 minutes and then remove 1. Boil some water in a saucepan. from the heat. 2. Break each egg separately into a cup or mug and then 3. Toast the bread and cut it into slices. gently add it to the boiling water. 3. Poach the eggs for about 3 minutes. 4. Toast the bread. 5. Serve the eggs on the toast. Garnish with the tomatoes. 30 31

Snacks 200kcal

Tomato soup and crispbread DAIRY-FREE Tomato soup 200g Crispbread 15g

Tomato soup and crispbread This recipe makes 4 portions of about 215g.

2 large cans (400g) tomato soup* 4 crispbreads

* Check the label and choose soup that has a high tomato content (for example over 90% tomatoes) and a lower salt content.

1. Heat the soup, following the instructions on the can. 2. Serve each bowl of soup with a crispbread.

Malt loaf with a satsuma DAIRY-FREE Pear and almonds DAIRY-FREE

Malt loaf 60g Pear 150g Satsuma 100g Almonds (shelled) 30g 32 33

Snacks 250kcal

Cheese and tomato quesadillas French toast

Cheese and tomato quesadillas 140g French toast 110g

Cheese and tomato quesadillas French toast This recipe makes 4 portions of about 140g. This recipe makes 4 portions of about 110g.

1 tablespoon tomato purée 4 eggs 1 teaspoon mild chilli powder 120ml semi-skimmed milk 4 medium tomatoes, diced 4 large slices (120g) wholemeal bread 60g Cheddar cheese, grated 20g butter 8 small tortilla wraps 1 teaspoon ground cinnamon

1. Mix together the tomato purée, chilli powder, diced 1. Break the eggs into a bowl and beat together with the tomato and cheese. milk. 2. Place a tortilla in a frying pan and spread with a quarter 2. Dip the slices of bread in the milk mixture until fully of the tomato mixture. Place another tortilla on top and coated. dry-fry until brown. Turn the tortilla over and dry-fry until 3. Heat a pan and melt the butter. Don’t let the butter go brown. brown. 3. Remove the tortilla from the pan and cut into triangles. 4. Fry the bread until the egg mixture is cooked on both 4. Repeat steps 2 and 3. sides, turning the bread to ensure even cooking. 5. Sprinkle with the cinnamon before serving.

32 33

Snacks 250kcal

Leek and potato soup with a wholemeal roll Tuna melt muffin

Leek and potato soup 250g Tuna melt muffin 140g Wholemeal roll 80g Tuna melt muffin Leek and potato soup This recipe makes 4 portions of about 140g. This recipe makes 4 portions of about 250g. 2 muffins 4 medium leeks 4 teaspoons tomato purée 1 tablespoon vegetable oil 2 medium tomatoes, sliced 1 onion, peeled and diced 1 can (185g) tuna in spring water, drained and flaked 2 medium potatoes, peeled and roughly chopped 60g Cheddar cheese, grated 500ml water 1 bay leaf Each portion uses 1/2 muffin, 1 teaspoon of tomato purée, 1/2 teaspoon black pepper powder 1/2 tomato, 1/4 can tuna and 15g Cheddar cheese. 1 teaspoon salt 250ml semi-skimmed milk 1. Cut the muffins in half. 2. Spread the tomato purée on the cut surface of the 1. Chop the top off the leeks and trim the roots. Chop the muffins, and then layer on the sliced tomato and tuna. leeks in half lengthways and wash under running water, Sprinkle with cheese and then cook under a hot grill until fanning out the layers, to make sure they are thoroughly browned. clean. Chop the leeks roughly. 2. Heat the oil in a large pot over a medium heat and add the leeks, onions and potatoes. Stir, reduce the heat to low, and simmer gently for 10 minutes, stirring occasionally to stop browning. 3. Add the water, bay leaf and seasoning, stir well and bring to the boil. Then reduce the heat, cover and simmer for 15 minutes, until the potatoes are soft. 4. Take out the bay leaf and purée the soup in a liquidiser or with a hand-held blender. Add the milk, and heat through before serving. 34 35

Snacks 250kcal

Mexican scrambled egg wrap Mexican scrambled egg 100g Tortilla wrap 40g

Mexican scrambled egg This recipe makes 4 portions of about 100g.

4 eggs 2 teaspoons butter 2 spring onions, chopped 2 medium tomatoes, diced 1 teaspoon mild chilli powder

Each portion uses 1 egg, 1/2 teaspoon of butter, 1/2 spring onion, 1/2 tomato and 1/4 teaspoon of chilli powder.

1. Beat the eggs in a bowl. 2. Melt the butter in a non-stick saucepan. 3. Add the eggs, stirring all the time over a low heat until the egg is thoroughly set. 4. Mix in the spring onions, tomatoes and chilli powder.

Pitta bread pizza Pitta bread pizza 110g

Pitta bread pizza This recipe makes 4 portions of about 110g.

4 pitta breads 4 teaspoons tomato purée 120g grated cheese 60g mushrooms

Each portion uses 1 pitta bread, 1 teaspoon of tomato purée, 30g cheese and 1 or 2 mushrooms.

1. Heat the grill to a medium temperature and toast the pitta breads on one side. 2. Remove the bread from the grill and place the tomato purée, mushrooms and cheese on the untoasted side of the pitta bread. 3. Place under the grill for a few minutes until the cheese has melted.

Tip: You could try using other vegetables for toppings. Peppers, sweetcorn or left-over vegetables can be used instead of mushrooms. 34 35

Snacks 250kcal

Scrambled egg and tomato with toast Tortilla crisps with a curry dip and a small glass of orange juice and apple

Scrambled egg 55g Tortilla crisps 40g Grilled tomato 80g Curry dip 50g Wholemeal toast 35g Apple 80g Vegetable fat spread 8g Orange juice 150ml Tortilla crisps This recipe makes 4 portions of about 40g. Scrambled egg This recipe makes 4 portions of about 55g. 4 small tortilla wraps

4 eggs Each portion uses 1 tortilla wrap. 2 tablespoons milk 4 teaspoons butter 1. Heat the oven to 200°C / 400°F / Gas 6. 2. Cut the tortillas into triangles and spread out in a single Each portion of scrambled egg uses 1 egg, layer on a baking tray. Bake in the oven for about 10 to 15 1/2 tablespoon of milk and 1 teaspoon of butter. minutes until crisp.

1. Beat the eggs in a bowl with the milk. Curry dip 2. Melt the butter in a non-stick saucepan. This recipe makes 4 portions of about 50g. 3. Add the eggs, stirring all the time over a low heat until the egg is set thoroughly. 1/2 small onion, grated 1 teaspoon curry powder 1 teaspoon garlic powder 1 teaspoon sugar 1 teaspoon horseradish sauce 1 teaspoon cider vinegar 150g fromage frais 1 heaped tablespoon reduced-fat mayonnaise

1. Mix all the ingredients together in a small bowl and chill until serving. 36 37

Snacks 250kcal

Apple and cinnamon crumble and custard Apple and cinnamon crumble 90g Custard 80g

Apple and cinnamon crumble This recipe makes 4 portions of about 90g.

75g plain flour 75g porridge oats 2 teaspoons ground cinnamon 2 tablespoons brown sugar 60g vegetable fat spread 500g cooking apples

1. Heat the oven to 180°C / 350°F / Gas 4. 2. Grease the base of a small, deep, ovenproof dish with a little vegetable fat spread. 3. Mix all the dry ingredients together. 4. Melt the vegetable fat spread and add it to the dry ingredients. Mix well with a fork until a crumbly texture is achieved. 5. Peel, core and slice the apples and put them in layers in the base of the dish. 6. Place the crumble mixture on top of the apples and bake for 45 minutes until golden.

Mango fritters with yoghurt Mango fritters 130g Yoghurt 50g

Mango fritters This recipe makes 4 portions of about 130g.

75g plain flour 1 large egg 60ml semi-skimmed milk 2 large ripe mangos 20g sugar 1 tablespoon vegetable oil

1. Sift the flour into a large bowl. 2. Make a well in the centre of the flour, add the egg and gradually beat in the milk to form a smooth batter. 3. Mash the mangos and then add them and the sugar to the batter and mix well. 4. Heat the oil in a frying pan. Once hot, fry spoonfuls of the mixture for about 2 minutes on each side. Serve immediately.

36 37

Snacks 250kcal

Porridge with jam and a small glass of orange juice Porridge 250g Jam 10g Orange juice 150ml

Porridge This recipe makes 4 portions of about 250g.

1 litre semi-skimmed milk 125g rolled oats

Each portion uses 250ml of milk and about 30g of oats.

1. Place the milk and oats in a non-stick saucepan. 2. Heat gently until boiling, and then turn the heat down and simmer, stirring occasionally, until the oats are softened and have absorbed the milk.

Quick microwave sponge pudding and custard Quick microwave sponge pudding 60g Custard 60g

Quick microwave sponge pudding This recipe makes 4 portions of about 60g.

75g vegetable fat spread 75g caster sugar 75g self-raising flour 1 large egg 1 tablespoon semi-skimmed milk 4 tablespoons of fruit (for example, blackberries, blackcurrants, raspberries or chopped canned fruit)

This recipe is made in the microwave. You will need either 4 small pudding pots (plastic or ceramic), or 1 larger bowl to make one big pudding.

1. Put the vegetable fat spread, sugar, flour, egg and milk together in a large bowl and beat together until well mixed and smooth. 2. Place the fruit in the bottom of the individual bowls or a large bowl. 3. Divide the sponge mix between the bowls or place it in the large bowl. 4. Cover with cling film and microwave on high for 1 minute for an individual pudding, or for about 4 minutes for a large pudding. 5. Remove the cling film and turn the pudding upside down onto a plate. 38 39

Snacks 250kcal

Rice pudding with canned mandarin oranges Rice pudding 200g Mandarins canned in juice (drained) 50g (= 1/3 of a 300g can of mandarins)

Rice pudding This recipe makes 4 portions of about 200g. 80g pudding rice 900ml milk 1 tablespoon sugar 1 tablespoon butter 1/2 teaspoon ground cinnamon or nutmeg (optional)

1. Place the rice and milk in a saucepan and bring to the boil. Reduce the heat and simmer for 30 to 35 minutes, stirring occasionally. 2. Add the sugar and butter and then stir until the sugar has dissolved and the butter has melted. 3. Sprinkle with cinnamon or nutmeg before serving.

Weet bisks with milk and raisins Weet bisks 40g (2 weet bisks) Semi-skimmed milk 150ml Raisins 20g 38 39

Snacks 250kcal

Baguette with houmous, and carrot and Baked beans and French stick DAIRY-FREE cucumber sticks DAIRY-FREE

Baguette 60g Baked beans 200g Houmous 40g French stick 40g Carrot sticks 80g Cucumber sticks 40g Baked beans and French stick This makes 4 portions of about 240g.

2 large (400g) cans reduced-salt and reduced-sugar baked beans 1/2 large French stick

Chick pea dahl with chapatti DAIRY-FREE Wholemeal chapatti 50g Chick pea dahl 100g

Chick pea dahl This recipe makes 4 portions of about 100g.

1 tablespoon vegetable oil 1 teaspoon cumin seeds 1 large onion, diced 1 clove garlic, finely chopped 1/2 teaspoon ground ginger 1 teaspoon mild chilli powder 1 teaspoon ground turmeric 1 large can (400g) chick peas, drained 100ml water

1. Heat the vegetable oil in a large pan and fry the cumin seeds for about a minute, until they ‘pop’. 2. Add the onion, garlic, ginger, chilli powder and turmeric and fry for several minutes until the onions soften. 3. Add the drained chick peas to the pan, along with the water, and cook for 5 to 10 minutes, stirring occasionally. 40 41

Snacks 250kcal

Liver pâté and oatcakes, with celery sticks Mini fish finger sandwich DAIRY-FREE DAIRY-FREE

2 fish fingers 56g Oatcakes 24g Baguette 50g Liver pâté 50g Lettuce 20g Celery sticks 40g Tomato 30g

Note: If you’re on a dairy-free diet, check that the fish fingers are free from dairy products.

Mixed nuts and almond milk DAIRY-FREE Sardines on toast, with tomatoes DAIRY-FREE

Mixed unsalted nuts 40g Sardines 45g Unsweetened calcium-fortified almond milk 200ml Wholemeal toast 30g Cherry tomatoes 30g

Sardines on toast This recipe makes 4 portions of about 100g.

4 large slices (120g) wholemeal bread 2 cans (120g) sardines in brine, drained (180g drained weight) 120g cherry tomatoes

1. Toast the bread. 2. Serve with the sardines and tomatoes. 40 41

Snacks 250kcal

Omelette with grilled tomato and toast and a small glass of orange juice DAIRY-FREE Omelette 60g Grilled tomatoes 80g Wholemeal toast 35g Dairy-free spread 8g Orange juice 150ml

Omelette This recipe makes 4 portions of about 60g.

4 large eggs 2 tablespoons water 2 teaspoons dairy-free spread

Each portion of omelette uses 1 large egg, 1/2 tablespoon of water and 1/2 teaspoon of dairy-free spread.

1. Break the eggs into a jug or mixing bowl. 2. Add the water to the eggs and beat together using a fork. 3. Heat an omelette pan or frying pan over a medium heat. 4. Add the dairy-free spread to the hot pan and as soon as it sizzles, swirl the pan and add the egg mixture. Don’t allow the spread to brown. 5. Allow the egg mixture to cook until the omelette is set. 6. Fold the omelette in half and serve.

Baked banana DAIRY-FREE Baked banana 200g

Baked banana This recipe makes 4 portions of about 200g.

8 small bananas 4 tablespoons orange juice 2 teaspoons brown sugar 4 orange slices for garnish (optional)

Each portion uses 2 small bananas, 1 tablespoon of orange juice and 1/2 teaspoon of sugar.

1. Lay the bananas in a flat bowl suitable for the microwave or grill. 2. Pour the orange juice over the bananas and sprinkle with the sugar. 3. Either cover with cling film and microwave on high for about 3 minutes until the bananas are soft, or place under a hot grill for 4 to 5 minutes.

42 43

Snacks 250kcal

Pitta bread crisps with a chilli dip and grapes Carrot cake DAIRY-FREE DAIRY-FREE

Pitta bread crisps 50g Carrot cake 65g Chilli dip 30g Grapes 80g Carrot cake This recipe makes 8 portions of about 65g. Pitta bread crisps This recipe makes 4 portions of about 50g. 1 large carrot, peeled 1 egg 4 pitta breads 75g brown sugar 5 tablespoonfuls vegetable oil Each portion uses 1 pitta bread. 75g wholewheat flour 1 teaspoon ground cinnamon 1. Heat the oven to 200°C / 400°F / Gas 6. 1/4 teaspoon nutmeg 2. Cut the pitta bread open all the way through. Cut each 25g sultanas piece into triangles and spread them out in a single layer 1 teaspoon mixed spice on a baking tray. Bake in the oven for about 7 minutes 1/2 teaspoon bicarbonate of soda until crisped and beginning to brown. 1/2 teaspoon baking powder

Chilli dip 1. Heat the oven to 180°C / 350°F / Gas 4. This recipe makes 4 portions of about 30g. 2. Grease the base of a small baking tin with a little vegetable oil and line with baking parchment. 3. Grate the carrot. 1/2 small (200g) can chopped tomatoes 4. Whisk the egg and sugar together until thick and creamy. 1/2 jalapeño pepper, de-seeded and finely chopped 5. Whisk in the oil. Slowly add the grated carrots and the 2 spring onions, finely chopped remaining ingredients and mix together. 2 teaspoons fresh parsley, chopped 6. Spoon the mixture into the prepared tin, level the surface 1 teaspoon sugar and bake for 20 to 25 minutes until firm to the touch and 1/2 clove garlic, crushed golden brown. 1/2 tablespoon white wine vinegar 7. Cool on a wire tray. 1/2 tablespoon lemon juice

1. Mix all the ingredients together. Chill before serving. 42 43

Breastfeeding and eating well 44 45 Breastfeeding

n the UK, it is recommended that women exclusively breastfeed for the first six months of their baby’s life, continue to breastfeed as they introduce Icomplementary foods in the second six months, and then continue breastfeeding for as long after that as they wish.

Any breastfeeding that mums can do is a good thing, and every day counts when it comes to Breastfeeding helplines breastfeeding. To find out v more about the benefits of National Breastfeeding Helpline breastfeeding for you, your (English, Welsh and Polish) baby and the world around 0300 100 0212 you, see Breastmilk and The National Breastfeeding Helpline is run in breastfeeding: A simple collaboration with the Breastfeeding Network guide, available at www. and the Association of Breastfeeding Mothers. firststepsnutrition.org or La Leche League GB any of the resources listed on 0345 120 2918 page 60. NCT Support Line 0300 330 0700

You can talk to a breastfeeding counsellor and get answers to all your practical breastfeeding questions from the helplines listed opposite. Ask your midwife, health visitor or local children’s centre for contact details for local support groups for breastfeeding mums. See also the Start4Life website www.nhs.uk/start4life/ breastfeeding and the organisations listed on page 60. 44 45 Eating and drinking well when breastfeeding

• If you are breastfeeding, a normal, healthy, balanced diet is recommended. See Eating well for everyone on page 8 for more on this. • You might need some extra energy (calories). How much extra you may need depends on whether you are exclusively breastfeeding or mixed feeding (a combination of breastfeeding and formula feeding). • You should take a daily vitamin D supplement. • You are likely to need to drink a bit more than usual. Be guided by your thirst. • There are a few foods and drinks that breastfeeding mothers should limit, or avoid.

We explain all this in more detail below.

How much extra energy (calories) might you need when breastfeeding?

Women aged 19-50 years have an average daily energy requirement of 2,100 calories (kcal). Women aged 15-18 years need 2,400 calories a day, as they are still growing. For the time that you are breastfeeding, you may need some extra energy (calories), on top of that requirement. However, some women find their appetite does not increase and, unless you feel hungry or are losing too much weight, there is no need to try and eat more.

Government nutrition experts have calculated that: • An average woman who is exclusively breastfeeding her baby may need about 300 extra calories a day for about the first six months of her baby’s life. • Mums who mixed feed or just offer one or two breastfeeds a day may find they don’t need anything extra at all, but may find an extra snack or milky drink helps them to manage their appetite.

It’s important that, if you feel hungrier, you get your extra energy from nutritious snacks and drinks, rather than from high-fat, high-sugar foods. On pages 19-42 we suggest a range of extra snacks, foods and drinks that provide the additional energy and nutrients that breastfeeding mums might need. 46 47

Will I need extra calories while I’m breastfeeding?

Mums who exclusively breastfeed throughout the first year of life (and beyond)

The first 6-9 months After 9 months When you are exclusively breastfeeding your After your baby is about 9 months old, and baby in the first 6 months, you may need for the rest of the time you continue to an extra 300 calories a day. If you carry on breastfeed, you may need an extra drink with breastfeeding as the baby’s main milk or snack of about 100 calories each day. drink after you have introduced solid food, However, everyone is different and, if you start you may still need the extra 300 calories a losing weight, you might need to eat a bit day until your baby is about 8-9 months old, more to maintain a healthy weight. but be guided by your appetite and weight. As the amount of food your baby eats goes up, the amount of milk he or she takes will go down. Babies are able to regulate their intake of food and breast milk. This Any breast milk you is one of many good reasons for can give your baby in the first carrying on breastfeeding, as the year of life and beyond will ability to regulate energy intake benefit both of you. So, if you and energy needs may protect can carry on offering some your baby from becoming breastfeeds once your baby overweight in later life. starts to have other food, that is highly recommended. Mums who choose mixed feeding (a mixture of breastfeeding and formula feeding)

If your baby has more than half of his or her If you breastfeed your baby for less than milk feeds as breast milk but you give some half of his or her feeds (1-3 feeds a day) formula feeds You may need about an extra 100 calories a You may need an extra 150-200 calories a day if you feel hungrier. day if you feel hungrier.

Choosing healthy snacks and drinks

If you do eat a bit more when you are breastfeeding, make sure the snacks and drinks you choose are nutritious. There are lots of examples of healthy snacks and drinks on pages 19-42. 46 47

Vitamin D supplements Why should breastfeeding How much vitamin D do I need mums take a daily vitamin D to take, and where can I get the supplement? supplements? Vitamin D is very important for bone health for A supplement of 10 micrograms (400 IU) of mothers and babies. Vitamin D comes from vitamin D a day is recommended, but the sun activating vitamin D in skin but, due supplement doses of up to 25 micrograms (1,000 to the UK’s northerly latitude, this only takes IU) a day can be safely taken. You can buy a place during the summer months. In the UK, vitamin D supplement cheaply at a pharmacy or all women, including those who are pregnant supermarket. and breastfeeding are recommended to take a daily vitamin D supplement. This is especially If you’re eligible for Healthy Start, you can important for: get free Healthy Start vitamins until your child is 1 year old. (See below for information about • women who have darker skin Healthy Start.) Healthy Start vitamins contain 10 • women who rarely go outside micrograms of vitamin D, as well as folic acid and vitamin C. The Healthy Start vitamins are suitable • women who cover their skin with clothing or for breastfeeding women. They are suitable for sunscreen vegetarians, but not for vegans. • teenagers and younger women If you follow a vegan diet, you will need to use • women who do not eat animal products, and a non-animal sourced vitamin D supplement (see • women who eat a very poor diet. below).

Which vitamin D supplements should I take?

If you are eligible for If you are not eligible for Healthy Start Healthy Start

All breastfeeding mums, Healthy Start vitamin drops You can buy Healthy Start except for vegans These contain 10 micrograms of vitamins from a pharmacy, vitamin D. or take a single vitamin D supplement. 10 micrograms a day is recommended.

Vegan breastfeeding Healthy Start vitamins are not Veg1 supplement mums suitable for vegans. Available from the Vegan Society. This contains 10 micrograms of vitamin D from vegan sources.

Vitashine vitamin D supplement This contains 1000 IU (equivalent to 25 micrograms) of vitamin D from vegan sources. 48 49

Do I need to take any Thirst supplements other than Making breast milk uses extra fluid, so you might vitamin D? find you’re more thirsty than usual. There is no set amount for how much you need to drink, No. Unless you have been prescribed a specific as it depends on the weather conditions, your supplement by your GP, the most important activity level and the foods you eat. Be guided thing you can do is eat well to get all the by your thirst. Don’t be tempted to ignore it nutrients you need. Taking lots of supplements because you’re busy. Perhaps make it part of is associated with poorer health, and more is your breastfeeding routine to have a glass of definitely not better when it comes to most water or a water bottle next to you each time vitamins and minerals. If you are planning a you give your baby a feed. Carrying a water further pregnancy, taking a folic acid supplement bottle with you when you’re out and about also is also recommended (see page 7). You can makes it easy to have a drink when you need it. carry on breastfeeding if you are trying for For information on having drinks such as tea and another baby or are pregnant. Information on coffee when breastfeeding, see the next page. supplements you may need if you follow a vegan diet can be found on page 47. Drinking lots of fluid won’t increase your milk supply. An effective latch and frequent breastfeeding will Getting enough calcium increase milk supply. For information Getting enough calcium in the diet is on where to find trained particularly important for breastfeeding mums. support to improve your If you drink milk or eat cheese and yoghurt, milk supply, see page 60. you can get enough calcium quite easily. If you don’t eat dairy foods, it is important to include other good sources of calcium in your diet every day. We have suggested a range of additional foods and snacks from both dairy and dairy-free sources on pages 19-42. Many of the dairy-free food and snack suggestions are also good sources of some of the other important nutrients that dairy foods provide, such as iodine, riboflavin and zinc. 48 49

Are there some foods I should limit or avoid when I am breastfeeding? Most babies are not affected by the foods a mother consumes, and it is important not to confuse suspected hypersensitivity to food that mum consumes with normal infant behaviour, which can sometimes be unsettled. Most of the myths about foods to avoid are old wives’ tales. For example, some people say that eating cabbage or other green vegetables when breastfeeding can make a baby ‘gassy’, but mums cannot pass ‘gas’ through milk and this probably came from an idea that the person eating the cabbage might themselves have wind. However, it is likely that what the mum eats will affect the taste of the breastmilk. This makes sense as a way of familiarising the baby with tastes that they will encounter when they move from milk to solid food, and is not a reason to avoid certain foods. All babies will have days when they are fussy, bring up milk after a feed or just seem out of sorts for no particular reason, and some are more sensitive than others. The one thing you can be sure of is that there is nothing you can put into a sensitive infant’s stomach that will be easier to digest than breast milk.

Cows’ milk protein allergy A small number of babies can be allergic to cows’ milk protein which can be in their mother’s milk if she eats and drinks cows’ milk based foods. If you are concerned that your baby is having an immediate reaction to a feed (for example, by being sick, having a rash, a streaming nose, lumps appearing on the body or facial swelling) or a reaction over the longer term (for example, developing eczema, reflux, colic, poor growth, diarrhoea or being reluctant to feed), seek advice from your GP. If there is a severe immediate reaction after a feed that impacts on breathing, or if your baby goes floppy, call 999 for an ambulance. Ask your GP or health visitor for advice about how to carry on breastfeeding if your baby has a cows’ milk protein allergy. This will involve making some changes to your own diet to start with, and taking a supplement of calcium as well as the vitamin D you will be taking as a breastfeeding mum. You may be referred to a dietitian for advice on which foods and drinks to avoid. Continuing to breastfeed and avoiding cows’ milk in your own diet is the first line of treatment recommended for infants with cows’ milk protein allergy.

Caffeine Drinks that contain caffeine – Caffeine can pass through into breast milk and Aim to limit the amount of caffeine might affect your baby and may keep them awake. you have – in coffee, tea, cola and energy Caffeine is found particularly in coffee, tea and drinks – to no more than 200mg of chocolate. It’s also added to some soft drinks like caffeine a day. cola drinks and energy drinks, and to some cold •1 mug of filter coffee = 140mg and flu remedies. The general advice is to have no •1 mug of instant coffee = 100mg more than 200mg of caffeine a day in pregnancy 1 mug of tea = 75mg and this might be good advice when breastfeeding • 1 can of cola = 40mg as well. Decaffeinated tea and coffee taste the • same as those with caffeine and, while you and •1 can of energy drink = 80mg your baby both need all the sleep you can get, you Decaffeinated coffee and tea will be glad to avoid things that keep you awake! can be drunk freely. 50 51

Alcohol Other things to avoid Alcohol passes through to breastfed babies in Calabash chalk is eaten by some pregnant and small amounts, but it’s unlikely that having an breastfeeding women in some cultures, but this occasional drink will harm you or your baby. should be avoided as it is high in lead. When breastfeeding, it’s probably sensible to There is debate about the safety of a number of drink very little alcohol – for herbs and supplements when breastfeeding, example, no more than 1 or 2 and in general the advice is to avoid these in units once or twice a week. One any concentrated form. The amounts of these unit of alcohol is approximately a herbs normally used in cooking are unlikely to single (25ml) measure of spirits, be of concern; it’s mainly the larger amounts half a pint of beer, or half a that might be used as supplements that could standard (175ml) glass of wine, pose a problem. A few substances have been although it depends on the picked out as potentially dangerous when strength of the drink. breastfeeding, such as the herb chasteberry On average, it takes about 2 hours for your body (also called Abraham’s Balm or Monk’s Pepper to clear 1 unit of alcohol. If possible breastfeed and suggested as good for the reproductive your baby just before you have your drink, or system), the supplements conjugated linoleic time it so that your body can clear the alcohol acid and chitosan, and some Chinese herbal before your baby’s next feed. If you have an preparations. However, the safest option is occasion when you are planning to have more to avoid all supplements unless you have had than two drinks, plan ahead and express some specific advice from your GP that they are safe. breast milk beforehand so you can give this to your baby while you have alcohol in your system. Always consider the care of your baby if you are affected by alcohol: alcohol will make you less steady on your feet and will affect your judgement. Never go to sleep with your baby in a bed or on the sofa if you have been drinking alcohol.

Fish Eating fish is good for your health, but the current advice is to have no more than two portions of oily fish a week. Oily fish includes salmon, mackerel, sardines, trout and fresh tuna. Oily fish can contain low levels of pollutants. 50 51 Special diets

Dairy-free diets If you went through pregnancy on a vegetarian diet, you will have had your iron status checked Some mothers follow dairy-free diets either and, if you were prescribed iron tablets, your GP for cultural reasons or because they or their may suggest you carry on with these while you babies have an intolerance to the protein or breastfeed. lactose in cows’ or goats’ milk. Some cultural For more information on vegetarian diets, see the groups don’t traditionally eat dairy products Vegetarian Society website at www.vegsoc.org and need to get their calcium from other foods. Dairy products primarily supply calcium in the Western diet, but they are also a valuable source Vegan diets of protein and some vitamins like vitamin A, Vegans avoid all animal products so there are vitamin B2 (riboflavin) and vitamin B12. If you some nutrients that vegans are likely to need to swap cows’ milk for soya milk, almond milk, oat get from fortified foods or from supplements. milk or coconut milk, make sure the alternative Vegan pregnant women will have been is unsweetened and is calcium-fortified. Most recommended to take a supplement of vitamin fortified milks also add some other vitamins to B12, vitamin D and iodine during pregnancy, and make them more like animal milk. You can also should continue to take this when breastfeeding. use fortified plain soya yoghurt as an alternative to cows’ milk yoghurt. If you eat a dairy-free It is particularly important that vegan mums diet, there are other foods that are good take a vitamin D supplement when they are sources of calcium that you can eat. See Good breastfeeding. And breastfed babies are sources of vitamins and minerals on page 58, recommended to have a 8.5 microgram vitamin and the dairy-free snacks and drinks shown on D supplement from birth, or in some areas from pages 19-42. 1 month of age. Follow the advice of your health visitor. Mums who are avoiding dairy products because their baby has a cows’ milk protein allergy are Vegan mums are advised to seek advice from a often also advised to avoid soya milk alternative. health professional to ensure that If this is the case, instead of using soya milk they are getting all the nutrients alternative in recipes, use a different milk they and their baby need. The alternative such as one based on nuts or oats. Vegan Society is also a good Eating well: vegan infants source of information (see www. and under-5s vegansociety.com). Eating well Vegetarian diets advice for vegan infants and It is perfectly possible to get all the nutrients under-5s can be found in the needed from a diet that excludes meat, poultry resource Eating well: vegan and fish, as most vegetarians eat eggs, drink infants and under-5s, which is milk and have other dairy foods. If you follow a available at vegetarian diet, it is important to eat a range of www.firststepsnutrition.org meat alternatives and to regularly include in your diet eggs, peas, beans, lentils, nuts, soya products and other alternatives to meat. See Good sources of vitamins and minerals on page 58. 52 53 Frequently asked questions

hese are just a selection of questions that women have asked about breastfeeding and food and drink. If you have other questions, try one of the Tuseful sources of information or helplines listed on page 60.

Do I need to eat or drink differently when I breastfeed? Breastfeeding women, like all new mums, need to eat well to meet their own energy and nutrient needs, and in some cases to prepare their bodies for any future pregnancies. However, human beings are very efficient and, when you have a new baby, your body will absorb nutrients from food more efficiently. This ensures that enough breast milk is still produced even if a mum’s diet is poor. Of course, we want mums to be well nourished too, and many new mums are keen to adopt good eating habits as they know this will help them cope with the demands of being a mum. But even if you have not been eating well, breastfeeding is the best way to feed your baby. Also, it is important to remember that your breast milk is uniquely suited to your baby and will contain protective factors that infant formula cannot provide.

Can I still breastfeed if I have been I’m worried that I’m not skipping meals? producing enough milk for Yes, you can breastfeed your baby even if my baby. Who can I talk to you have not been eating well. We don’t about this? want mums to skip meals and not look after If you have any questions or concerns themselves, and it is important to talk to your about breastfeeding, there are lots of midwife or health visitor if you are worried about places you can turn to for help. See page how you are eating or how to access food. But 60 for a list of national organisations and carry on breastfeeding and try and eat as well helplines, and ask your health visitor or as you can. If you are on a low income, you midwife for local contact information. might be eligible to receive Healthy Start food Any question you have is valid and you vouchers and free vitamins (see page 7). Your really can ask breastfeeding supporters midwife or health visitor can tell you about this anything. Anyone who has been in your and can signpost you to other support if you are shoes will understand and really want struggling to eat well. to help!

I’m on a low income. Is it true that I can get food vouchers when I’m breastfeeding? If you are on a low income and are eligible for Healthy Start vouchers, you can use these when you are breastfeeding to buy fruit, vegetables and milk. You will get £6.20 worth of food vouchers a week (at 2017 values), as well as vitamin vouchers for the first year of your baby’s life. You can still eat well on a budget. The resource Making the most of Healthy Start offers advice on how to eat well using Healthy Start food vouchers and contains lots of cost-effective recipes. It is available at www.firststepsnutrition.org 52 53

Is it true that, if my baby has colic, I should I am breastfeeding drink less milk and avoid dairy foods? twins. Do I need extra It is unlikely that colic in your baby is related to what energy and nutrients? you eat or drink, but always talk to your health visitor or If you are exclusively midwife if you are concerned that your baby might have breastfeeding twins, you are cows’ milk protein allergy (see page 49). Colic – where likely to feel more hungry and babies cry persistently in the early weeks of life, often in may find you need to eat and the evenings – is common and while it is not harmful, it drink more during the day to can be distressing for families. If you are breastfeeding, maintain your weight. Talk to there are some simple things you can try to reduce colic: your health visitor or midwife changing the position you use when feeding, giving smaller if you are concerned about to and more frequent feeds, rocking and soothing your baby, how manage your own diet and holding your baby and offering comfort. You can during this very busy time. get advice on managing colic from anyone who supports breastfeeding mums (see page 60).

I am being sick. Is it safe to carry on breastfeeding? Yes. Your milk will help protect your baby from getting the same illness, or will at least make it milder. As with most illnesses, the antibodies you are making to fight the infection will be passed to your baby through your breast milk. If you are vomiting and/or have diarrhoea, try drinking water or other clear drinks to help you keep your fluid levels up. Even small amounts of fluid taken regularly will help. You don’t need to eat food to keep making milk. Your breasts may feel softer, but you will still have enough milk. When you are ill, your baby may want to feed for shorter times but more often. If you feel ill, stay in bed (if you can) to feed your baby. See your GP if you are not feeling better in a few days.

Can I breastfeed if I have diabetes? If you have diabetes – either before your pregnancy or if you were diagnosed with gestational diabetes during pregnancy – you can breastfeed just the same as women who do not have diabetes. To make sure you get off to a good start, it is useful to talk to a trained breastfeeding counsellor before you give birth, so that you can be prepared for any challenges in the first few days. Breast milk contains lactose – a milk sugar. Breastfeeding mothers will therefore be transferring lactose to their baby during each breastfeed, resulting in the mother’s blood sugar lowering after feeds. You will have been given antenatal and postnatal information and support about managing diabetes while breastfeeding. Diabetes UK recommends that breastfeeding women aim to consume around 40-50g more starchy foods a day to manage ‘losses’ due to breastfeeding, and in some cases they may need to lower their insulin requirement. Make sure you have a plan in place with the diabetes team. While your sugar levels can influence the lactose in your milk, the diabetic medication you take – such as insulin, metformin and sulphonylureas – should not directly affect your baby. 54 55

Is it true that, if I breastfeed, Can I eat liver or have liver I’m more likely to get back to pâté when breastfeeding? the weight I was before my Yes. There is no risk to your baby if pregnancy? you eat these foods, and liver is a Yes. You may find it takes a while to return cheap and very nutritious food that to your pre-pregnancy weight, but evidence many people enjoy. Pregnant women, suggests that, after three to four months, however, are advised to avoid liver most breastfeeding women are slimmer and liver pâté as these foods are very than formula-feeding women who eat fewer high in vitamin A which may harm a calories. For more on weight, see page 14. growing baby.

Is it sensible to diet when breastfeeding? Breastfeeding your baby is a really good way to get back to your pre-pregnancy weight, especially if you breastfeed for the first six months or more. In the first two months after giving birth, you should give your body time to recover from the birth and get breastfeeding well established, so eating healthily and introducing gentle activity into your day should be your priority. If you’re worried about your weight and size, talk to your midwife, health visitor or GP, as there is specific advice for mums after they have given birth. Every mum wants the best for their baby, and your baby needs a happy mum who can offer them a safe, loving environment and this is likely to be your priority rather than getting back into a specific size of clothes in the early months. If you are advised to reduce your energy intake to lose weight, you will still be able to make the best breast milk for your baby.

I drink lots of diet cola drinks. Does it matter if I Do I need to avoid carry on when I breastfeed? spicy food? Most cola drinks, whether they are branded or supermarket own If you enjoy spicy food, brands, contain about 10mg of caffeine per 100ml. A can or there is no reason to bottle of cola contains between 30mg and 50mg of caffeine. avoid it when you are So, if you drink a lot of these drinks, you can get a lot of caffeine, breastfeeding. Few and if you also have some tea or coffee, you might end up having babies react to what quite high intakes of caffeine. Some breastfeeding mums find mum eats and, if breast that when they consume high levels of caffeine it makes their milk takes on a different baby unsettled and irritable. Some colas don’t have any caffeine flavour, this is all part of in them and you can check the label to find out which ones these nature’s way of getting are. Drinking lots of diet drinks is also damaging to teeth, as these your baby used to life in drinks contain acid, which damages the enamel of the teeth. your family! There is also some evidence that people who drink a lot of diet drinks actually find it harder to stay slim than those who don’t. Too much of any one food or drink is generally a bad idea, so try swapping some of your diet cola drinks for drinks of water, milk or one of the other nutritious drinks suggested in this resource. 54 55

If I eat foods like unpasteurised If I eat junk food and take- cheese or sushi, can I pass listeria aways, will this affect my on to my baby? baby’s health? You cannot pass listeria on through breastmilk to No. You will still produce breast milk, your baby and there is no reason for breastfeeding which is the best choice for your baby mums to avoid these foods, as long as the usual whatever your diet. Obviously a diet food safety rules are followed. For advice on which high in foods with lots of fat, salt and foods and drinks you should limit or avoid when sugar in them is not a good choice long breastfeeding, see page 49. term for anyone, and we want mums to be healthy too, but your body has an Pregnant women are advised to avoid foods amazing ability to produce breast milk that might carry the food bacteria listeria and so regardless of how good your own diet is. unpasteurised milk and cheese, some blue cheeses, For advice on what a healthy diet looks raw fish and shellfish and undercooked meats or like for women, see the resource Eating meals should all be avoided during pregnancy. well recipe book (see page 7).

Can herbal remedies increase milk supply? Many cultures around the world have used herbal preparations to promote milk supply over many centuries, but there is little clear evidence that they work. Some of those preparations typically promoted include fenugreek, alfalfa, blessed thistle, fennel and anise, as well as mixed herbal teas. Some herbs can cause tummy disturbances but are often safe when consumed as ‘teas’ where the herb is covered in boiling water and then the tea is drunk. The most important thing is that any herbal preparation you take should be safe, and it is a good idea to talk to your pharmacist before taking any non-food preparation. There are also some medicines that can be prescribed to increase milk supply, but most women can produce enough milk if their baby is latched on effectively, if they let their baby feed frequently (including at night in the early days), and if the mother gets plenty of rest and fluid. Avoid the herb chasteberry (also called Abraham’s Balm or Monk’s Pepper and suggested as good for the reproductive system), the supplements conjugated linoleic acid and chitosan. Be careful with Chinese herbal preparations and make sure you check these with a pharmacist.

Will garlic increase my milk supply? When should I start to give Garlic is believed by many people to be a my baby food other than galactogogue – the name given to a substance that milk? encourages milk production. It has been used for The advice in the UK is that most many years as a herbal treatment to stimulate breast babies should start being offered milk production and increase milk supply. There is no some foods complementary to clear evidence that eating garlic will alter your milk breast milk at about 6 months of supply, but the garlic that you eat may slightly change age. Some babies may be ready the taste and smell of your breast milk. This is a good for foods a bit before, and some a thing for many babies who will later move on to having bit after 6 months, but make sure garlic-flavoured food that the rest of the family enjoys. complementary foods are introduced Some babies like the taste and are not at all bothered no later than 7 months of age. by garlic, while others may become fussy and irritated. 56 57 56 57

Additional information 58 59 Good sources of vitamins and minerals

Animal sources Non-animal sources Vitamin A butter apricots (dried, fresh or canned) canned salmon blackcurrants cheese broad beans egg broccoli full-fat milk Brussels sprouts herrings cabbage (dark) kidney canteloupe melon liver * carrots pilchards canned in tomato sauce honeydew melon smoked mackerel mango margarine nectarine orange peach peas prunes red peppers runner beans spinach sweet potatoes sweetcorn tomatoes * Avoid liver and liver products if you are pregnant. watercress

Animal sources Non-animal sources Riboflavin cheese almonds eggs fortified breakfast cereals Also called vitamin B2 kidney granary bread lean meat or poultry mushrooms mackerel soya beans milk spinach pilchards wheatgerm bread salmon sardines tuna yoghurt

broccoli peanuts Brussels sprouts peas Folic acid cabbage potatoes ‘Folic acid’ is the name given cauliflower runner beans to the synthetic form of the fortified breakfast cereals spinach B vitamins known as folates, green leafy salads tomatoes but is used as a general term melon wholemeal bread here for this vitamin. oranges yeast extract parsnips

Dairy sources Non-dairy sources Calcium milk canned salmon cheese dried fruit cheese spread egg yolk yoghurt muesli fromage frais orange peas, beans and lentils pilchards, sardines soya drink fortified with calcium spinach tofu white bread / flour 58 59

Animal sources Non-animal sources Iron All meat and meat products provide baked beans iron, but very good sources include blackcurrants darker meats and meat products black-eyed peas made from beef, lamb, duck, venison, broad beans and offal meats such as heart, liver *, broccoli kidney, oxtail and tongue. chick peas dried apricots Oil-rich fish – including herrings, fortified breakfast cereals pilchards, sardines, salmon, whitebait lentils and tuna – are also a good source of raisins iron. soya beans spinach Eggs (particularly egg yolk) are also a spring greens good source. tofu weet bisks white bread * Avoid liver and liver products if you are pregnant. wholemeal bread/flour

Dairy sources Non-dairy sources Iodine butter egg cheese fish fromage frais fish paste milk seaweed ice cream shellfish yoghurt

Animal sources Non-animal sources canned sardines beans and lentils Zinc canned tuna or pilchards brown or wholemeal bread cheese nuts cold cooked meats plain popcorn eggs sesame seeds ham tofu kidney wholegrain breakfast cereals, such as lean meat puffed wheat, branflakes liver* or weet bisks milk poultry shrimps and prawns

* Avoid liver and liver products if you are pregnant.

60 61 For more information

Best Beginnings is a charity working to end child Breastfeeding helplines health inequalities in the UK. It offers information about pregnancy, birth, mental health, premature and National Breastfeeding Helpline sick babies, and breastfeeding. (English, Welsh and Polish) Their DVD From bump to breastfeeding, which 0300 100 0212 follows real mothers’ stories, shows parents how to The National Breastfeeding Helpline is run in get started with breastfeeding and provides practical collaboration with the Breastfeeding Network answers to common problems. It can be viewed in and the Association of Breastfeeding Mothers. seven languages including Urdu, Bengali and Somali. Sections of the DVD are available as video clips from La Leche League GB www.bestbeginnings.org.uk/fbtb. The website also 0345 120 2918 has videos on: Breastfeeding twins or more; and Breastfeeding your sick or pre-term baby. NCT Support Line Baby Buddy is a free mobile phone app for parents 0300 330 0700 and parents-to-be, covering pregnancy and the first six months after birth. It delivers personalised pregnancy and parenting information and prompts for reflection and action. The app is available to Useful organisations and sources download from the App Store or Google Play. of information Bliss Association of Breastfeeding Mothers T: 020 7378 1122 T: 08444 122 948 E: [email protected] Helpline: 0300 330 5453 www.bliss.org.uk E: [email protected] Bliss is a special care charity which provides www.abm.me.uk information about feeding babies born too soon, too This charity offers extensive support to parents small, or too sick. around breastfeeding and a range of factsheets and resources as well as a helpline. Information is The Breastfeeding Network available on a wide range of topics such as expressing T: 0844 412 0995 breast milk, breastfeeding twins, breastfeeding older Helpline: 0300 100 0212 children, and the roles of parents and grandparents. www.breastfeedingnetwork.org.uk The Breastfeeding Network is a UK charity that The Baby Café provides evidence-based information and support www.thebabycafe.org for breastfeeding women and their families. It does Coordinates a network of breastfeeding drop-in centres not take funding from sources with an interest in and other services to support breastfeeding mothers. commercial feeding. Some useful factsheets are: Baby Milk Action (IBFAN UK) Expressing and storing breast milk T: 01223 464420 https://www.breastfeedingnetwork.org.uk/wp- www.babymilkaction.org content/pdfs/BFNExpressing_and_Storing.pdf Baby Milk Action (IBFAN UK) is a campaigning Mastitis and breastfeeding organisation that protects breastfeeding by www.breastfeedingnetwork.org.uk/wp-content/ highlighting inappropriate marketing of breastmilk dibm/BFN%20Mastitis%20feb%2016.pdf substitutes. Baby Milk Action works within a global network to strengthen independent, transparent How safe is …? Alcohol, smoking, medicines and and effective controls on the marketing of the baby breastfeeding feeding industry. www.breastfeedingnetwork.org.uk/wp-content/ pdfs/BfN_how_safe_is_leaflet_2009.pdf Best Beginnings The Breastfeeding Network also runs the Drugs in T: 020 7443 7895 Breastmilk Information Service (see the next page). E: [email protected] www.bestbeginnings.org.uk 60 61

Department of Health Lactation Consultants of Great Britain The Department of Health provides free information www.lcgb.org about infant feeding. E: [email protected] Lactation Consultants of Great Britain is the Off to the best start: important information association for those with the qualification of the about feeding your baby is a downloadable booklet International Board Certified Lactation Consultant that covers many aspects of infant feeding (breast (IBCLC). It specialises in promoting, protecting and and bottle) such as preparation for breastfeeding, supporting breastfeeding and lactation issues. It is dealing with problems such as mastitis, a healthy an affiliate member of ILCA (International Lactation diet for breastfeeding, and formula feeding – Consultants Association). To find your nearest IBCLC, including preparation of bottles. See www.gov.uk/ go to www.lcgb.org/find-an-ibclc/f government/publications/off-to-the-best-start- important-information-about-feeding-your-baby La Leche League GB Helpline: 0345 120 2918 Drugs in Breastmilk Information Service www.laleche.org.uk www.facebook.com/ BfNDrugsinBreastmilkinformation La Leche League GB is a support network that offers information and encouragement, mainly through The Drugs in Breastmilk Information Service Facebook mother-to-mother support, to all women who want page provides information on medication use when to breastfeed their babies. It holds regular meetings, breastfeeding. open to mothers, all over the UK. To find your nearest Factsheets are available at: La Leche League breastfeeding mothers’ group, go to www.breastfeedingnetwork.org.uk/drugs-factsheets/ www.laleche.org.uk/find-lll-support-group/ For help with specific questions about medicines or For information on a wide range of topics related to treatments, email: breastfeeding, see: [email protected] www.laleche.org.uk/get-support/#bfinfo

Feedgood Maternity Action www.feedgood.scot Maternity Action Maternity Rights Advice Line: A comprehensive information source for parents on 0808 802 0029 all aspects of breastfeeding, provided by the Unicef www.maternityaction.org.uk UK Baby Friendly Initiative, NHS Scotland and the Maternity Action is committed to ending inequality Scottish Government. The website contains ‘How to’ and improving the health and well-being of pregnant breastfeeding guides by baby’s age, and information women, partners and young children from conception and support for mums, partners, families and friends. through to the child’s early years. They also support Useful articles include: recognising feeding cues, the rights of women to breastfeed in the workplace. breastfeeding positioning and attachment, and managing frequent feeding. See: Midwives Information and Resource Service www.feedgood.scot/how-to-guides (MIDIRS) T: 0800 581 009 First Steps Nutrition Trust www.midirs.org See page 64 for information on healthy eating produced by First Steps Nutrition Trust. Multiple Births Foundation T: 020 3313 3519 www.multiplebirths.org.uk Healthy Start www.healthystart.nhs.uk The Multiple Births Foundation supports multiple- birth families. They have produced free feeding Healthy Start is the UK welfare food scheme which guidelines for parents and carers. Their booklet provides free vitamins and food vouchers for low- Feeding twins, triplets and more is available income families. for download at: www.multiplebirths.org.uk/ MBFParentsFeedingGuideFINALVERSION.pdf Institute of Health Visiting www.ihv.org.uk The Institute of Health Visiting provides useful fact sheets and training for health visitors, and fact sheets for families. 62

National Breastfeeding Helpline Public Health Wales National Breastfeeding Helpline Bilingual resources (in English and Welsh) on T: 0300 100 0212 (available in English, Welsh and breastfeeding can be accessed at Polish) www.wales.nhs.uk/sitesplus/888/page/61619/ The National Breastfeeding Helpline is open from Bump, Baby & Beyond (In English and Welsh) 9.30am - 9.30pm every day of the year. It offers www.wales.nhs.uk/documents/Pregnancy%20 independent, confidential, mother-centred, non- to%204%20Years%20Book%20FINAL%20 judgemental information and support about English%20Revised%20E-Book%20Compressed.pdf breastfeeding. The helpline is run in collaboration A book that provides parents with support from the with the Association of Breastfeeding Mothers and the early stages of pregnancy, through to the early days Breastfeeding Network and is funded by Public Health with your baby and into the toddler years. England and the Scottish Government. A web chat service is also available. Ready, Steady, Baby www.readysteadybaby.org.uk NCT NHS Health Scotland website covering the time from T: 0844 243 6000 deciding to have a baby, through pregnancy and NCT Support Line: 0300 330 0700 birth, and up until your baby is 12 months. www.nct.org.uk Royal College of Midwives The NCT is a national parenting charity that offers T: 0300 303 0444 advice and information on breastfeeding, including E: [email protected] a helpline. A full list of their factsheets is available www.rcm.org.uk at: www.nct.org.uk/parenting. You can choose information targeted at babies from 0-3 months; 3-6 Start4Life months; 6-9 months; 9-12 months; 12-18 months; and www.nhs.uk/start4life 18-24 months. For information on breastfeeding, including how to See also the web pages: know if your baby is feeding well, how families and How long should I breastfeed? carers can support breastfeeding, and breastfeeding www.nct.org.uk/parenting/how-long-should-i- out and about, see: breastfeed www.nhs.uk/start4life/breastfeeding Coping with colic The website has a large range of videos, including: www.nct.org.uk/parenting/coping-colic Getting started with breastfeeding; Birth, skin-to-skin Dads and breastfeeding – common concerns and the first feed; Expressing and storing breastmilk, www.nct.org.uk/parenting/dads-and-breastfeeding- Hand expression, Feeding out and about and common-concerns Overcoming challenges. See: www.nhs.uk/start4life/breastfeeding-videos NHS Choices www.nhs.uk Tamba: Twins and Multiple Births Association www.tamba.org.uk The NHS Choices website has information on all T: 01252 332 344 aspects of breastfeeding at www.nhs.uk/Conditions/ pregnancy-and-baby Tamba produces a leaflet called Breastfeeding more than one, which gives advice on managing Public Health Agency (Northern Ireland) breastfeeding for twins or triplets or more. Off to a good start: All you need to know about breastfeeding your baby www.publichealth.hscni.net/sites/default/files/ offtoagoodstart_march_2017.pdf What dads should know about breastfeeding www.publichealth.hscni.net/sites/default/files/ What_dads_should_know_03_15.pdf 63

Unicef UK Baby Friendly Initiative Support for postnatal depression T: 020 7375 6052 E: [email protected] Association for Postnatal Illness www.unicef.org.uk/babyfriendly/ Helpline: 020 7386 0868 www.apni.org The Unicef UK Baby Friendly Initiative website contains Provides a telephone helpline, information leaflets useful information and advice on all aspects of and a network of volunteers who have themselves breastfeeding. It provides resources for parents at: experienced postnatal depression. www.unicef.org.uk/babyfriendly/baby-friendly- resources/leaflets-and-posters/ Best Beginnings It also provides free access to research on infant www.bestbeginnings.org.uk feeding, including on topics such as: breastfeeding The Baby Buddy App produced by Best Beginnings has and skin to skin; breastfeeding and breast cancer; a series of films to support women from their ‘Out of breastfeeding and tongue tie; and breastfeeding and the Blue’ project. allergy. See: www.unicef.org.uk/BabyFriendly/News- https://www.bestbeginnings.org.uk/out-of-the-blue and-Research/Research Cry-sis Off to the best start Helpline: 08451 228669 www.unicef.org.uk/Documents/Baby_Friendly/ www.cry-sis.org.uk Leaflets/4/otbs_leaflet.pdf Provides self-help and support for families with A downloadable booklet produced jointly by Unicef excessively crying and sleepless and demanding babies. UK Baby Friendly Initiative and the Department of Health. It provides information about all aspects of breastfeeding, including for multiple births. Printed Family Action copies are available for free by phoning the DH T: 020 7254 6251 Publications Orderline on 0300 123 1002. www.familyaction.org.uk Support and practical help for families affected by Breastfeeding at study or work – information for mental illness, including Newpin services – offering employees and employers support to parents of children under 5 whose mental www.unicef.org.uk/babyfriendly/wp-content/ health is affecting their ability to provide safe parenting. uploads/sites/2/2008/04/breastfeedingandwork.pdf Guide to bottle feeding Home-Start Infant formula and responsive bottle feeding: T: 0800 068 6368. A guide for parents www.home-start.org.uk Both of these are available at: Home-Start provides support and practical help for www.unicef.org.uk/babyfriendly/baby-friendly- families with at least one child under 5. It offers help resources/leaflets-and-posters/guide-infant-formula- to parents finding it hard to cope for many reasons, parents-bottle-feeding/ including postnatal depression or other mental illness, isolation, bereavement, or illness of a parent or child.

Maternal Mental Health Alliance www.maternalmentalhealthalliance.org Their website includes information about Mums and Babies in Mind projects across the UK. See: www.maternalmentalhealthalliance.org/resources/ mothers-and-families/

Pandas Foundation Helpline (open 9am to 8pm): 0843 2898401 www.pandasfoundation.org.uk An organisation that helps individuals and their families with pre- and postnatal depression advice and support. They also offer support to families in the antenatal period. 64 65 First Steps Nutrition Trust – Useful resources

The information in all our resources is in line with current policy and has been reviewed by experts in the field. All our resources are available as free pdfs to download at www.firststepsnutrition.org Hard copies are available at cost price from www.fbsresources.com

Supporting women in pregnancy and new mums

Eating well for a healthy pregnancy Eating well in pregnancy Eating well for new mums A practical guide A practical guide to support teenagers Including information for breastfeeding mothers

This guide enables health professionals This practical guide illustrates what This resource encourages all new to support pregnant women about a good diet looks like for young mums to eat well and summarises food, nutrition and pregnancy. It women in pregnancy. The advice current thinking on food, nutrition includes recipes and meal ideas and is tailored to women aged 15-19 and breastfeeding. It provides photos can sit alongside other local public years and provides practical ideas and recipes for a range of simple, health guidance to provide a practical on how to eat well cost-effectively. nutritious light meals and snacks explanation of what ‘eating well’ looks It includes photos and recipes, all of perfect for busy mums on the go. like in practice. which have been tested and costed.

Supporting low-income families

Eating well recipe book Simple, cost-effective ideas for the whole family Making the most of Healthy Start A practical guide

1

1

This resource explains the UK-wide Healthy Start scheme Simple cost-effective recipes for the whole family and and how families eligible for this scheme can be tips on how to eat well on a budget and with limited supported. The resource gives examples of how the food equipment. Recipes show how adults, teenagers, vouchers can be spent, with recipes and advice for health school-aged children, under-5s and infants can all professionals who support families in their areas. eat well from the same recipes. 64 65

Supporting new families

Eating well: the first year A guide to introducing solids and eating well up to baby’s first birthday

This resource explains how to safely introduce solids and This resource summarises how vegan infants (and their how to encourage eating well in the second six months mums) and children under 5 can be supported to eat well. of life. The resource provides recipes, suggested portion It provides simple, cost-effective and tested recipes that sizes and lots of practical tips. can be used in early years settings or in the home, and clear information on how to support vegan dietary choices.

Supporting 1-4 year olds and early years settings

Eating well: snacks for Portions previewPortions - Fruit preview - Meat, Beans Alternatives 1-4 year olds Coming Eating well: Packed lunches for 1-4 year olds in 2017 Good food choices and portion Apple_green_slices.psd Baked_beans.psd sizesApple_red_slices.psd for Chick-peas.psd1-4 year olds Portions preview - Vegetables Portions preview - Meat, fish, eggs This resource gives

Baby_carrots.psd Apricot.psd Red_kidney_beans.psd Beetroot.psd Avocado.psdPoached_chicken.psdRed_lentils.psd Beef.psd information on healthy snacks to give to 1-4 year olds.

Broad_beans.psdBanana_halved.psd Green_lentils.psd Broccoli.psd Banana_sliced.psdPork.psd Mini_falafels.psd Minced_lamb.psd

Brussel_sprouts.psd Butternut_squash.psd Canned_sardine.psd Canned_tuna.psd This resource Eating well: the pre-school years This guide outlines how This pictorial guide shows the will summarise families and early years sorts of foods, and amounts all the latest settings can prepare packed of foods that can be offered advice on what lunches which meet the to 1-4 year olds to encourage eating well energy and nutrient needs of eating well as part of a looks like for young children, using cost- healthy meal plan. 1-4 year olds. effective choices that meet a wide range of needs. Coming in 2017 66 Index

A S activity 15 sickness 53 alcohol 50 snacks 18, 19 special diets 51 B spicy food 54 breastfeeding 44 starchy foods 9 supplements 7, 47, 48, 50, 55 C sushi 55 caffeine 49 Calabash chalk 50 T calcium 48 take-aways 55 cheese 11, 55 thirst 48 colic 53 twins 53 complementary feeding 55 cows’ milk protein allergy 49 V vegans 51 D vegetables 10 dairy products 11 vegetarians 51 dairy-free diets 51 vitamin D supplements 7, 47, 51 diabetes 53 vitamins 7, 58 dieting when breastfeeding 54 vomiting 53 drinking 48 drinks 18, 19, 48 W weight 14, 54 E eatwell plate 8 energy requirements 18, 45 exercise 15

F fish 12, 50 fluid 48 formula feeding 6 fruit 10

G garlic 55

H Healthy Start 7 helplines 60 herbal remedies 55

I infant formula 6

M meat 12 menu plans 16 milk products 11 minerals 58

P post-pregnancy weight loss 14, 54 pregnancy 14 www.firststepsnutrition.org

Eating well for new mums

ISBN 978-1-908924-46-9 (e-book) ISBN 978-1-908924-42-1 (hard copy)